Inflammation of the conjunctiva, most common cause of a red eye
Clinical presentation
Common Symptoms
- Redness of one or both eyes
- Foreign body sensation
- Ocular discharge
- Excessive tearing (epiphora)
- Pruritus (especially in allergic conjunctivitis)
Etiology-Specific Features
Etiology | Characteristic Findings |
Bacterial | Purulent or mucopurulent discharge, eyelids stuck together on awakening |
Viral | Watery discharge, follicular reaction, preauricular lymphadenopathy |
Allergic | Intense itching, bilateral involvement, stringy or mucoid discharge |
Gonococcal | Copious hyperpurulent discharge, marked eyelid edema, rapid progression |
Chlamydial | Chronic course, follicular conjunctivitis, persistent hyperemia |
Investigations
Conjunctivitis is primarily a clinical diagnosis, but additional investigations may be indicated in selected cases:
- Clinical Examination
- Visual acuity assessment
- Slit-lamp biomicroscopy
- Evaluation of discharge, conjunctival reaction, and corneal involvement
- Laboratory and Ancillary Tests (when indicated)
- Gram stain and culture of conjunctival discharge (severe or refractory cases)
- Polymerase chain reaction (PCR) for adenovirus or Chlamydia trachomatis
- Allergy testing in severe or recurrent allergic conjunctivitis
- Fluorescein staining to exclude corneal epithelial defects or keratitis
Viral Conjunctivitis
- Most common cause
Causative organisms
- Adenovirus (most common)
- Herpes simplex
- Herpes zoster- shingles as well usually just on the ophthalmic branch and maybe on the nose.
Clinical features
- Sudden onset, rapidly progressive
- Typically bilateral, often manifests in one eye before spreading to the other
- Some patients will have associated URT - dry cough, sore throat and blocked nose
- Adenoviral - watery discharge
- Herpes simplex - cutaneous vesicles develop on the eyelids and on the skin around the eyes
- Herpes zoster - shingles rash
Management
- Adenovirus → lubrication with artificial tears, cold compress (self-limiting)
- Herpes simplex & herpes zoster → Acyclovir 3% ointment 5x1 for 10 days
Complications
- Over 50% of patients with herpes simplex conjunctivitis will develop a dendritic ulcer
Bacterial Conjunctivitis
Causative organisms
Neonates
- Staphylococcus aureus
- Neisseria gonnorhoeae
- Chlamydia trachomatis
- All cases in neonates should be referred to opthalmology
All other ages
- Staphylococcus aureus
- Streptococcus pneumoniae
- Hamophilus influenzae (especially in children)
Clinical features
- Even more abrupt onset than viral disease, spreads to both eyes within 48 hours
- Morning crusting
- Copious mucopurulent yellow discharge
- Papillae
Management
- Chloramphenicol 1% ointment 3x1 for 3 days
- Chloramphenicol 0.25% ED 6x1 for 3 days
Chlamydial Conjunctivitis
Clinical features
- Often chronic history unresponsive to treatments
- Suspect in bilateral conjunctivitis in YAs
- May or may not have symptoms of urethritis, vaginitis
- Can be passed from mother to newborn
Management (topical + oral)
- Topical oxytetracycline
- Tetracyclin 1% ointment 4x1 for 3 weeks
- Erythromycin 0.5% ointment 4x1 for 3 weeks
- Oral antibiotics
- Azithromycin 1 g SD
- Doxycyclin 100 mg 2x1 for 7 days
- Need contact tracing
Complications
- Can cause subtarsal scarring if not treated
Allergic Conjunctivitis
- Most cases seasonal as a result of pollen allergy, can occur due to allergens e.g. animal dander
Clinical features
- Watery, itchy eyes
- Bilateral and symmetrical ocular involvement with global injection and chemosis
Management
- Avoid triggers
- Cool compresses, oral/topical antihistamines for symptomatic relief
- Mast cell stabiliser — sodium cromoglycate 2% ED 4x1/2
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